Respi- asthma Flashcards
What is asthma?
Asthma is a heterogeneous disease characterized by chronic airway inflammation, defined by a history of respiratory symptoms such as wheeze, shortness of breath (SOB), chest tightness, and cough that vary over time and in intensity.
List the respiratory symptoms associated with asthma.
Intermittent symptoms (wheezing, cough, dyspnea, chest tightness)
Worse at night or early morning
Episodic exacerbations triggered by allergens, infections, exercise
Reversible airflow limitation on spirometry
What are the phenotypes of asthma?
- Allergic
- Non-allergic asthma
- Cough variant
- Adult onset
- Asthma with persistent airflow limitation
- Asthma with obesity
What is the significance of lung function tests (LFT) in asthma diagnosis?
Increase in LFT 10-15 minutes after bronchodilation or trial of ICS; LFT may improve gradually, so reassessment is needed after at least 4 weeks.
What are the criteria for the initial diagnosis of asthma in adults and children aged 6-11 years?
- Symptoms occur variably over time and vary in intensity
- Symptoms are often worse at night or on waking
- Symptoms are often triggered by exercise, laughter, allergens, or cold air
- Symptoms often appear or worsen with viral infections
What is confirmed airflow limitation in asthma diagnosis?
Spirometry (increase in FEV1 > 10% after bronchodilators)
True or False: Symptoms of asthma are consistent and do not vary over time.
False
What should be done periodically for ongoing risk assessment in asthma management?
Record the patient’s personal best lung function periodically.
What is the relevance of viral infections in asthma symptoms?
Symptoms often appear or worsen with viral infections.
What is the purpose of the step-down approach in asthma management?
To adjust treatment based on the patient’s control and symptoms.
What are the key pathophysiological mechanisms of asthma?
- Airway inflammation – Eosinophilic, neutrophilic, or mixed inflammation
- Bronchoconstriction – Smooth muscle hyperresponsiveness to triggers
- Airway remodeling – Mucus hypersecretion, thickened basement membrane, fibrosis
What are common triggers for asthma?
- Allergens (dust mites, pollen, pet dander, mold)
- Irritants (smoke, pollution, strong odors)
- Exercise (especially in cold air)
- Infections (viral URIs)
- Weather changes (cold air, humidity)
- Medications (NSAIDs, β-blockers)
- Emotional stress
What are the key physical exam findings in asthma?
- Wheezing (expiratory > inspiratory)
- Prolonged expiratory phase
- Hyperresonance (air trapping)
- Use of accessory muscles (severe cases)
- Silent chest (ominous sign in severe asthma)
What are the classifications of asthma severity? What is classification primarily used for?
- Intermittent – Symptoms <2 days/week, FEV1 >80%
- Mild persistent – Symptoms >2 days/week but not daily, FEV1 >80%
- Moderate persistent – Daily symptoms, FEV1 60-80%
- Severe persistent – Symptoms throughout the day, FEV1 <60%
Used to guide stepwise approach
What are the diagnostic tests for asthma?
- Spirometry: ↓FEV1, ↓FEV1/FVC, reversible with bronchodilator >10% increase in FEV1
- Bronchoprovocation test (if spirometry is inconclusive)
- Peak expiratory flow rate (PEFR): Used for monitoring
- Fractional exhaled nitric oxide (FeNO): Reflects airway inflammation
What are the signs of a severe asthma attack?
- Inability to speak full sentences
- Use of accessory muscles
- Respiratory rate >30/min
- PEFR <50% predicted
- Silent chest (ominous sign)
- Cyanosis, altered mental status (impending respiratory failure)
What is the management of an acute asthma exacerbation?
- Oxygen to maintain SpO2 > 90%
- SABA (Albuterol) via nebulizer or MDI with spacer
- Corticosteroids (oral prednisone or IV methylprednisolone)
- Ipratropium (SAMA) in severe cases
- Magnesium sulfate IV for refractory cases
- Intubation & ICU admission if respiratory failure develops
What is the mainstay of long-term asthma treatment?
ICS
